Walcott, Dexter W

Walcott, Dexter W is an individual health care provider with primary practice located at 1513 Lakeland Dr. Suite 101, Jackson MS 39216. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as his primary health care specialty. Walcott, Dexter W can be contacted via phone (601) 354-4836.

Contact Information

Primary practice address
1513 Lakeland Dr. Suite 101 Jackson MS 39216
Phone: (601) 354-4836
Fax: (601) 354-2619
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 10031 Mississippi

Profile Details

NPI number 1457321325
LBN Legal business name Walcott, Dexter W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated Jul 20th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457321325 NPPES
Mississippi MEDICAID 00113910
Mississippi MEDICAID 00112408

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